Wednesday, May 7, 2014

Discussing Low Dose Daily Aspirin Use


Make sure that you understand the dosage and type of aspirin your physician has ordered.  Sometimes dissolving aspirin is ordered and other times enteric is chosen.  Low dose aspirin is usually 81 mg. per tablet.  The two aspirin you and I might take for a headache is a dosage of ten grains, or about 325 mg. per tablet.

      This week, the US FDA has cautioned people on the unsupervised use of a low dose aspirin tablet daily.  The fact is, that no one should have been using a low dose aspirin daily without having it been suggested/ordered by their physician.

            Aspirin is a remarkable drug. It not only is an effective anti-inflammatory, and an effective anti-pyretic (it lowers fevers), but it impedes clotting.  If aspirin hadn't been in widespread use for centuries, then the FDA would have made it a prescription drug !    It has miraculous properties and those same properties can be devastatingly dangerous when used on the wrong patient or during a particular period of vulnerability.  In a patient who has some degree of coronary artery disease, or who has had a heart attack, one solitary 81 mg (low dose) aspirin can prevent the formation of clots and can be an effective adjunct in the prevention of another heart attack.   However, in an alcoholic, or a person with problematic GERD, or a history of gastrointestinal bleeding, or liver disease, a daily aspirin, even in low dose, can cause gastrointestinal bleeding which can become so severe that I am left in the ICU transfusing a unit at a time in one arm, then the other, and then a third unit in the arm with which we started ! (Later that day, the patient will go for colonoscopy and for in effect, a cauterization of the bleeding area, but they still often need the blood they lost replaced.)
            Sometimes, a patient who really needs a daily low dose aspirin does actually have some other issues which make the practice dangerous, and then it's up to the physician to formulate a plan which manages such risks.  For example, in a patient with a history of controlled Crohn's Disease who also has coronary artery disease, he may need the aspirin, but there are concerns about potential activation of Crohn's Disease and gastrointestinal bleeding.  Sometimes the physician will order regular dissolving 81 mg. aspirin for a week, and then an enteric coated 81 mg aspirin they can alternate. This would at least, theoretically change the place of delivery to the gastrointestinal tract minimizing at least some of the potential for ulceration.
             Some of the patients who may benefit from a daily low dose aspirin a day are those with coronary artery disease, and especially those who have already had one heart attack (myocardial infarction).  Sometimes people with heart rhythm disturbances, especially atrial fibrillation have had low dose aspirin ordered.  This may help to prevent strokes and blood clots for them.  People who have something called anti-phospholipid syndrome also may benefit from daily low dose aspirin therapy. Certain patients who have had transient ischemic attacks, or mini-strokes might also benefit.   Some people with simple hypertension may also benefit.  Women who have a history of preeclampsia/toxemia in pregnancy can often avoid the syndrome using a physician ordered low dose aspirin until the last couple of weeks of their pregnancies. Some diabetics and those with certain types of dementia may also benefit.

            The patients for whom we worry a great deal about a daily low dose aspirin are those with a pre-existing clotting disorder, those with a known brain injury, (which could be bleeding), those with a liver disorder (as they may not clot readily), pregnant women who have had uterine bleeding during their pregnancy, those with known unhealed peptic or duodenal ulcers, those with esophageal ulcers or cancer, those with active Crohn's Disease or ulcerative colitis.

            There is a good recent study which seems to indicate that many patients who benefit from low dose aspirin could take it three times a week and enjoy the positive effects of the regimen while diminishing the bleeding risk somewhat.  This is something you should discuss with your physician.

            If you are taking 81 mg. aspirin daily, do not discontinue or wean this drug without first discussing this action with your physician.

               Be careful not to take aspirin along with other pain relievers (such as ibuprofen, which also impacts blood clotting times and gastrointestinal health.  As your physician or nurse practitioner for guidance when you need pain management and are taking a low dose daily aspirin.

          This one miraculous drug used in small dose is one of the reasons that so many people are attaining such a ripe and still productive old age.  Check with your primary physician as to whether you would benefit from its use, or whether you are one of the patients for whom it is potentially hazardous.